A foraminotomy procedure is performed under a general anaesthetic in most cases, although some patients may undergo a minimal access procedure under a local anaesthetic. Cervical spinal procedures will usually be under general anaesthetic to avoid the risk of movement during this type of delicate neck surgery. Patients’ respiratory and cardiac functions will be monitored during the operation and they may be advised to wear surgical stockings throughout to reduce the risk of thrombophlebitis occurring. Anaesthetic gas is more usually used in a foraminotomy as the operation is relatively short compared to surgeries requiring intravenous anaesthetic administration.
To begin the foraminotomy the surgeon will make a small incision above the vertebral level where the nerve compression is occurring. They will then use either retractors and clamps to push and hold the spinal tissues aside or a series of dilators and tubular retractors if they are conducting a minimally invasive procedure. A burr (small rotary cutting implement) is sometimes used to shave the inside edge of the facet joint and allow access to the outer edge of the foramen through which the nerve passes. If the vertebrae above or below the compressed nerve are also impinging on the area then the surgeon may also use the burr to remove a small portion of the ring at the back of these vertebrae. As well as removing bone, the surgeon may extract small fragments of disc and any bone spurs that are present so as to alleviate the pressure on the nerve root. The disc may be palpated if it is bulging so as to encourage decompression and proper reconfiguration of the vertebral space.
After satisfactorily opening up (widening) the neural foramen, the surgeon will remove the retractors and ease the soft tissues and muscles back into place. If more than one level of vertebrae is being operated on then the surgeon will either use the existing incision prior to closing the overlying skin back together, or make a separate incision at the appropriate level.
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